Diagnostic microbiology and infectious disease最新文献

{"title":"Antibiotic resistance and bacterial spectrum in cerebrospial fluid cultures: Initial insights from Pakistan","authors":"Zafar Mehmood ,&nbsp;Noman Asghar ,&nbsp;Ihtisham Ullah ,&nbsp;Ali Talha Khalil ,&nbsp;Arshad Islam ,&nbsp;Majid Khan ,&nbsp;Sami Ullah ,&nbsp;Siyab Ali ,&nbsp;Sadiq Ali Shah","doi":"10.1016/j.diagmicrobio.2025.116847","DOIUrl":"10.1016/j.diagmicrobio.2025.116847","url":null,"abstract":"<div><div>Antimicrobial resistance (AMR) is a rising global health concern, especially in resource-limited countries like Pakistan, where indiscriminate and unregulated use of antibiotics has significantly worsened this problem. The study aimed to analyze the bacterial spectrum and antimicrobial resistance patterns in cerebrospinal fluid (CSF) cultures from patients with suspected bacterial meningitis, providing crucial insights for better infection control and treatment strategies.This retrospective study analyzed 1107CSF cultures were between 2019 and 2024 at the Lady Reading Hospital, MTI, Khyber Pakhtunkhwa, Pakistan, to assess bacterial profiles in patients with suspected bacterial meningitis and investigate the AMR patterns. Among the 106 positive growth cultures, gram-negative bacteria accounted for 84.9 %. Alarmingly, <em>Acinetobacter baumannii</em> was found to be completely resistant to all the nine antibiotics tested, while <em>Salmonella typhi</em> showed resistance to six out of seven tested antibiotics, highlighting their severe multi-drug resistance profile. Moreover, notable resistance was observed in <em>Citrobacter freundii, Enterobacter</em> species, and <em>Staphylococcus aureus</em>. The distribution results indicated that the <em>Klebsiella pneumoniae</em> is more prevalent in males and the 1–13 years age group. These findings highlight the necessity for urgent action on antibiotic stewardship, improved surveillance, and public awareness to mitigate the spread of AMR pathogens, particularly in life-threatening infections such as bacterial meningitis. Strengthening infection control measures and regulating antibiotic usage policies is imperative to curb the growing AMR crisis.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116847"},"PeriodicalIF":2.1,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Vitro activity of ceftobiprole against 20,255 recent clinical bacterial isolates in Canada (CANWARD 2015-2023)","authors":"Élodie Gemme ,&nbsp;Andrew Walkty ,&nbsp;Melanie Baxter ,&nbsp;Heather J. Adam ,&nbsp;Philippe Lagacé-Wiens ,&nbsp;Karl Weiss ,&nbsp;James A. Karlowsky ,&nbsp;George G. Zhanel ,&nbsp;the Canadian Antimicrobial Resistance Alliance (CARA)","doi":"10.1016/j.diagmicrobio.2025.116838","DOIUrl":"10.1016/j.diagmicrobio.2025.116838","url":null,"abstract":"<div><h3>Background</h3><div>Ceftobiprole is a fifth-generation cephalosporin active against methicillin-resistant <em>Staphylococcus aureus</em> (MRSA). In this study, we determined the <em>in vitro</em> activities of ceftobiprole and comparator agents against 20,225 common Gram-positive and Gram-negative bacteria isolated from patients who presented for care at 16 tertiary-care hospitals across Canada between 2015 and 2023.</div></div><div><h3>Methods</h3><div>Minimum inhibitory concentrations (MICs) were determined using the Clinical and Laboratory Standards Institute (CLSI) reference M07 broth microdilution method. MICs were interpreted using CLSI M100 breakpoints where available. As CLSI does not publish MIC breakpoints for ceftobiprole, ceftobiprole MICs were interpreted using United States Food and Drug Administration (FDA), European Committee on Antimicrobial Susceptibility Testing (EUCAST), and Health Canada breakpoints.</div></div><div><h3>Results</h3><div>Ceftobiprole inhibited 100 % of MRSA at ≤ 4 μg/ml; 100 % of methicillin-susceptible <em>S. aureus</em> (MSSA) and 99.8% of MRSA at ≤ 2 μg/ml; 100 % of <em>Streptococcus pneumoniae</em> and <em>Streptococcus pyogenes</em> at ≤ 0.5 μg/ml; and 97.9 % of ESBL-negative <em>Escherichia coli</em>, 97.4 % of ESBL-negative <em>Klebsiella pneumoniae</em>, 97.8 % of <em>Proteus mirabilis</em>, 89.3 % of <em>Serratia marcescens</em>, 78.2 % of <em>Enterobacter cloacae</em>, 55.7 % of <em>Klebsiella oxytoca</em> at ≤ 0.25 μg/ml. Ceftobiprole was inactive against ESBL-positive <em>E. coli</em> and ESBL-positive <em>K. pneumoniae</em>.</div></div><div><h3>Conclusions</h3><div>Ceftobiprole demonstrated potent <em>in vitro</em> activity against MRSA, MSSA, <em>S. pneumoniae, S. pyogenes</em>, ESBL-negative <em>E. coli</em> and <em>K. pneumoniae</em>, and <em>P. mirabilis</em> isolated from clinical specimens of patients seeking care at Canadian tertiary-care hospitals.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116838"},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolation of Lancefieldella parvula in Secondary Infection from Human Bite: A Rare Occurrence","authors":"Samuel Jiménez Rayas ,&nbsp;Mercedes Isabel Cervantes Hernández ,&nbsp;Édgar Samuel Vanegas Rodríguez ,&nbsp;Claudia Adriana Colin Castro ,&nbsp;María Guadalupe Martínez Zavaleta ,&nbsp;Rafael Franco Cendejas ,&nbsp;Luis Esaú López Jácome","doi":"10.1016/j.diagmicrobio.2025.116842","DOIUrl":"10.1016/j.diagmicrobio.2025.116842","url":null,"abstract":"<div><h3>Background</h3><div>Human bite infections most commonly manifest as skin and soft tissue infections with lower infection rates than animal bites. <em>Lancefieldella parvula</em> is an anaerobe Gram-positive coccus found in human oral mucosa.</div></div><div><h3>Case Presentation</h3><div>We present the case of a 28-year-old healthy woman who suffered a deep skin and soft tissue infection in the left hand after a human bite. She presented with signs and symptoms of infection unresponsive to antibiotics, requiring admission for surgical debridement. Microbiological cultures were taken from the wound and empirical treatment was initiated with ciprofloxacin and clindamycin. Cultures were positive for <em>Lancefieldella parvula</em> by Matrix Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) which was genetically confirmed by 16S sequencing. The patient required two surgical debridements and digit amputation; and was treated with levofloxacin for five days recovered, achieving complete resolution of symptoms.</div></div><div><h3>Conclusions</h3><div>Timely surgical management and targeted antimicrobial therapy in severe human bite infections is crucial. The identification of <em>Lancefieldella parvula</em> using advanced tools like MALDI-TOF emphasizes the need to consider uncommon microorganisms in the differential diagnosis.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116842"},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare cause of fever of unknown origin in India","authors":"Bhagyashri B. Waghmare ,&nbsp;Prabhanjan V. Kulkarni","doi":"10.1016/j.diagmicrobio.2025.116845","DOIUrl":"10.1016/j.diagmicrobio.2025.116845","url":null,"abstract":"<div><div>In India, tuberculosis, lymphoma and adult onset Still's disease are the commonly reported causes of fever of unknown origin (FUO). We describe a case of an immunocompetent adult male patient who presented with FUO and anemia. He developed lymphadenopathy after 8 days of admission, for which further workup was done. His bone marrow aspirate showed pure red cell hypoplasia, for the evaluation of which, parvovirus-B19 (B19V) antibodies were ordered which came back positive. He was treated with a short course of steroids and on follow-up showed complete resolution of symptoms.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116845"},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment of a microfluidic and RPA-based platform for rapid multi-sample detection of Mycoplasma pneumoniae","authors":"Ling Zhang ,&nbsp;Cheng-Di Sun ,&nbsp;Jiao Luo ,&nbsp;Li-Guo Liang ,&nbsp;Si-Ming Lu","doi":"10.1016/j.diagmicrobio.2025.116840","DOIUrl":"10.1016/j.diagmicrobio.2025.116840","url":null,"abstract":"<div><h3>Background</h3><div><em>Mycoplasma pneumoniae</em> (<em>M. pneumoniae</em>) is a major respiratory pathogen causing atypical community-acquired pneumonia. Early and rapid diagnosis and timely detection of pathogens are crucial. RPA is an emerging PCR technology that allows amplification at room temperature compared to conventional PCR technology, while combining the advantages of rapid detection and high specificity of PCR technology, enabling rapid and accurate detection of pathogens.</div></div><div><h3>Methods and results</h3><div>In this study, we established a platform for detection <em>of M. pneumoniae</em> based on microfluidic and RPA technologies. The RPA technology is performed in 15 to 20 minutes, and only <em>M. pneumoniae</em> is significantly amplified at a sensitivity of 10 copies/μL; microfluidic technology provides lean instrumentation and a convenient interactive system. Three groups negative and positive QCs and 18 clinical samples can be tested in a single run.</div></div><div><h3>Significance</h3><div>In conclusion, we have established a microfluidic molecular assay operating system based on RPA technology, with the advantages of being simple, rapid, accurate and economical, and providing a new tool for laboratory detection of <em>M. pneumoniae</em>.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116840"},"PeriodicalIF":2.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successfully treated myopericarditis and acute heart failure due to severe Neisseria meningitidis infection: a case report","authors":"Nikolaos Nektarios Karamanolis ,&nbsp;Christos G Nikolaidis ,&nbsp;Ioannis Gavgiotakis ,&nbsp;Aikaterini Gaki ,&nbsp;Iraklis Tatsis ,&nbsp;Alexandra Mika ,&nbsp;George D Liatsos ,&nbsp;Dimitrios Vassilopoulos","doi":"10.1016/j.diagmicrobio.2025.116837","DOIUrl":"10.1016/j.diagmicrobio.2025.116837","url":null,"abstract":"<div><div><em>Neisseria meningitidis</em> is a known cause of bacterial meningitis and sepsis. It is rarely associated with serious cardiac manifestations. A 39-year-old woman diagnosed with meningococcal meningitis/septicemia developed myopericarditis leading to severe acute heart failure. Diagnosis was established by clinical, laboratory and echocardiographic findings and was later confirmed by cardiac MRI. Management included antibiotics, vasopressors and early intubation. Her course was further complicated with disseminated intravascular coagulation and unilateral hearing loss. Cardiac dysfunction resolved completely within 6 days. In conclusion, cardiac involvement is a possible contributor to shock in patients with meningococcal sepsis and should be promptly recognized and managed. Early intubation is a potential adjunct to medical treatment.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116837"},"PeriodicalIF":2.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and evaluation of ELISA serological immunoassays for influenza and respiratory syncytial viruses","authors":"Alexandra Claudet ,&nbsp;Noémi Alcover ,&nbsp;Elise Lebigot ,&nbsp;Hana-Sofia Bouhelal ,&nbsp;Fairly Warnakulasuriya ,&nbsp;Marie-Pierre Soutiere ,&nbsp;Marie Galloux ,&nbsp;Jean-François Eleouet ,&nbsp;Marie-Anne Rameix-Welti ,&nbsp;Etienne Bizot ,&nbsp;Christelle Vauloup-Fellous ,&nbsp;Vincent Portet-Sulla","doi":"10.1016/j.diagmicrobio.2025.116835","DOIUrl":"10.1016/j.diagmicrobio.2025.116835","url":null,"abstract":"<div><h3>Introduction</h3><div>Respiratory syncytial virus (RSV) and influenza are major causes of respiratory infections globally. Although vaccines are available, serological tools to assess population-level immunity and maternal antibody transfer remain limited. This study aimed to develop and evaluate ELISA assays for detecting anti-RSV and anti-influenza antibodies as a basis for future maternal-fetal immunity research.</div></div><div><h3>Materials and Methods</h3><div>In this study, we designed ELISA immunoassays using various influenza and RSV antigens. Sensitivity and specificity were calculated using sera from presumed seronegative infants and seropositive adults.</div></div><div><h3>Results</h3><div>The influenza vaccine-based ELISA achieved 98.3 % sensitivity and 100 % specificity. The pre-fusion F protein of RSV (Arexvy®) showed 97.5 % sensitivity and 97.4 % specificity. Other antigen combinations performed less optimally.</div></div><div><h3>Discussion</h3><div>These ELISA assays are scalable tools for seroepidemiological and maternal transfer studies. Future work will include correlation with neutralizing antibodies and paired maternal-infant analyses.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 3","pages":"Article 116835"},"PeriodicalIF":2.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Description of blaKPC-carrying Escherichia coli in patients from a Brazilian hospital over a 4-year period","authors":"Letícia Kalir Pradela ,&nbsp;Tiago Casella ,&nbsp;Fernanda Zani Manieri ,&nbsp;Letícia Kellen de Andrade ,&nbsp;Marlon do Valle Barroso ,&nbsp;Nguyen Thi Khanh Nhu ,&nbsp;Mark Andrew Schembri ,&nbsp;Cristiano Gallina Moreira ,&nbsp;Mara Corrêa Lelles Nogueira","doi":"10.1016/j.diagmicrobio.2025.116833","DOIUrl":"10.1016/j.diagmicrobio.2025.116833","url":null,"abstract":"<div><div><em>Klebsiella pneumoniae</em> carbapenemase (KPC)-producing <em>Escherichia coli</em> are recognized by the World Health Organization as a critical group of bacterial priority pathogens of public health importance. Thus, increased understanding of the genetic characteristics of KPC-producing <em>E. coli</em> is required. Here, we performed a retrospective study in a Brazilian teaching-hospital to describe the genomic features linked to antimicrobial resistance, virulence, and phylogeny of 40 meropenem-resistant <em>E. coli</em>. All isolates carried the <em>bla</em>_KPC-2 gene, but amikacin, tigecycline, colistin, polymyxin B, and fosfomycin showed good activity. Molecular typing by MLST revealed 20 sequence types (STs), with a predominance of ST131. Whole-genome sequencing identified Tn<em>4401</em> as a mechanism responsible for <em>bla</em>_KPC-2 mobilization, a variety of antimicrobial resistance and virulence genes, the predominance of pathogenic phylogroup lineages, and the grouping of genomes belonging to the same ST. KPC-producing <em>E. coli</em> is not a common pathogen, but few treatment alternatives are available against potentially virulent strains.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 3","pages":"Article 116833"},"PeriodicalIF":2.1,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of humoral and cellular responses after vaccination against SARS-CoV-2 in patients with immune-mediated diseases","authors":"Thomas Escoda ,&nbsp;Sylvie Jordana ,&nbsp;Laurent Chiche ,&nbsp;Guillaume Penaranda ,&nbsp;Stanislas Rebaudet ,&nbsp;Philippe Halfon","doi":"10.1016/j.diagmicrobio.2025.116825","DOIUrl":"10.1016/j.diagmicrobio.2025.116825","url":null,"abstract":"<div><h3>Background</h3><div>Patients with autoimmune disease (AID) or immunodepression (ID), particularly those treated with anti-CD20, have an increased risk of COVID-19 infection.</div></div><div><h3>Objective</h3><div>To characterise the humoral and cellular immune responses against specific antigens of SARS-CoV-2 in immunocompromised patients, as well as their correlation and determinants.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted in outpatients with AID and/or ID for which an assessment of their humoral and cellular response was carried out and analysed in relation to demographic data, comorbidities, treatments, type of vaccine and number of doses.</div></div><div><h3>Results</h3><div>Fifty patients were included. The overall serological response rate was 76%. The cellular response was positive in 54% of patients. The main factors influencing the humoral and cellular responses were age, comorbidities and treatment with anti-CD20.</div></div><div><h3>Conclusion</h3><div>In ID patients, vaccination against COVID-19 can generate an adequate T-cell response, the character of which is an emerging issue in the context of COVID-19 infection. The main limitations of this study and those in the literature are the heterogeneity of the patients included and the absence of a control population. These results highlight the importance of evaluating the antiviral T-cell response and the impact of immunosuppressive treatments.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 3","pages":"Article 116825"},"PeriodicalIF":2.1,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand, foot and mouth disease with encephalomyelitis in adult: A case report","authors":"Kieu Nguyet Oanh Pham ,&nbsp;Minh Cuong Duong ,&nbsp;Dinh Nam Vo ,&nbsp;Dang Trung Nghia Ho","doi":"10.1016/j.diagmicrobio.2025.116832","DOIUrl":"10.1016/j.diagmicrobio.2025.116832","url":null,"abstract":"<div><div>Hand, foot and mouth disease (HFMD) complications rarely develop in adults. We present a case of a 21-year-old woman with an acute onset of impaired consciousness, ptosis, and limb weakness. She had a history of close contact with an HFMD patient, fever, vesicles on her hands and nasopharynx, and decreased limb muscle power. The results of the head and spinal cord MRI and RT-PCR of cerebrospinal fluid and throat, skin lesion, and anal swabs confirmed enterovirus 71-induced encephalomyelitis. She received a single dose of IVIG therapy and fully recovered. Our report further confirms the possibilities of HFMD with severe neurological complications in adults. A history of contact with HFMD patients and lesions on the skin and mucosa, even unobvious, help diagnose the disease. Confirming central nervous system involvement requires cerebrospinal fluid analysis and brain and spinal cord MRI. Prompt IVIG treatment could help reduce fever, skin lesions, and recovery time.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 3","pages":"Article 116832"},"PeriodicalIF":2.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}